Department of Surgery, Urology Service, New York, NY, USA.
BJU Int. 2013 Feb;111(2):206-12. doi: 10.1111/j.1464-410X.2012.11638.x.
To compare early oncological outcomes of robot assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) performed by high volume surgeons in a contemporary cohort.
We reviewed patients who underwent radical prostatectomy for prostate cancer by high volume surgeons performing RALP or ORP. Biochemical recurrence (BCR) was defined as PSA ≥ 0.1 ng/mL or PSA ≥ 0.05 ng/mL with receipt of additional therapy. A Cox regression model was used to evaluate the association between surgical approach and BCR using a predictive model (nomogram) based on preoperative stage, grade, volume of disease and PSA. To explore the impact of differences between surgeons, multivariable analyses were repeated using surgeon in place of approach.
Of 1454 patients included, 961 (66%) underwent ORP and 493 (34%) RALP and there were no important differences in cancer characteristics by group. Overall, 68% of patients met National Comprehensive Cancer Network (NCCN) criteria for intermediate or high risk disease and 9% had lymph node involvement. Positive margin rates were 15% for both open and robotic groups. In a multivariate model adjusting for preoperative risk there was no significant difference in BCR rates for RALP compared with ORP (hazard ratio 0.88; 95% CI 0.56-1.39; P = 0.6). The interaction term between nomogram risk and procedure type was not statistically significant. Using NCCN risk group as the covariate in a Cox model gave similar results (hazard ratio 0.74; 95% CI 0.47-1.17; P = 0.2). The interaction term between NCCN risk and procedure type was also non-significant. Differences in BCR rates between techniques (4.1% vs 3.3% adjusted risk at 2 years) were smaller than those between surgeons (2.5% to 4.8% adjusted risk at 2 years).
In this relatively high risk cohort of patients undergoing radical prostatectomy we found no evidence to suggest that ORP resulted in better early oncological outcomes then RALP. Oncological outcome after radical prostatectomy may be driven more by surgeon factors than surgical approach.
比较高容量外科医生在当代队列中进行机器人辅助腹腔镜前列腺切除术（RALP）和开放式根治性前列腺切除术（ORP）的早期肿瘤学结果。
我们回顾了由高容量外科医生行 RALP 或 ORP 治疗的前列腺癌根治术患者。生化复发（BCR）定义为 PSA≥0.1ng/ml 或 PSA≥0.05ng/ml 并接受额外治疗。使用基于术前分期、分级、疾病体积和 PSA 的预测模型（列线图），使用 Cox 回归模型评估手术方法与 BCR 之间的关联。为了探讨外科医生之间差异的影响，使用外科医生代替手术方法重复多变量分析。
在纳入的 1454 例患者中，961 例（66%）接受了 ORP，493 例（34%）接受了 RALP，两组患者的癌症特征无明显差异。总体而言，68%的患者符合国家综合癌症网络（NCCN）中间或高危疾病标准，9%有淋巴结受累。开放组和机器人组的阳性切缘率均为 15%。在调整术前风险的多变量模型中，RALP 与 ORP 的 BCR 率无显著差异（风险比 0.88；95%CI 0.56-1.39；P=0.6）。列线图风险和手术类型之间的交互项无统计学意义。在 Cox 模型中使用 NCCN 风险组作为协变量，结果相似（风险比 0.74；95%CI 0.47-1.17；P=0.2）。NCCN 风险和手术类型之间的交互项也无显著性差异。两种技术之间的 BCR 率差异（2 年调整风险为 4.1%比 3.3%）小于外科医生之间的差异（2 年调整风险为 2.5%至 4.8%）。
在接受根治性前列腺切除术的这种相对高危患者队列中，我们没有证据表明 ORP 比 RALP 带来更好的早期肿瘤学结果。根治性前列腺切除术后的肿瘤学结果可能更多地受外科医生因素而不是手术方法的影响。
